My child _____________________________________________ has my permission to go to the Sports Emporium Roller Skating Rink in Carlisle on Sunday February 15th, 2009 from 4:00 PM to 6:30 PM. The entire immediate family may attend. Please bring your child to the rink. The troop will be paying the entrance fee;. You may either bring your own skates or rent ones from the rink. Regular skates are free, an upgrade to inline skates is $1.50. Please call me at 732-8849 or e-mail me at [email protected] and let me know if your daughter will be attending. A responsible adult must also stay with your child. She is in good physical condition and has had no serious illness or operation since her last health examination. During the activity I may be reached at: Address: _______________________________________________ Phone: _____________________________ If I cannot be reached in case of an emergency, the following person is authorized to act in my behalf: Name and Address: _______________________________________ ________________________________________ Relationship to participant: ______________________ Phone number: ____________________ Physician�s name and number: __________________________ ___________________________ Parent�s Signature: ____________________________________ Date: ___________________ ____ Yes, I would like to purchase the patch for $1.50 My daughter _____ will _____ will not be attending Due to the purchase of additional insurance a list of all participants must be supplied. Additional people skating ________________________________________ ________________________________________ ________________________________________ |
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